Normal labour and its management Flashcards
Causes of maternal morbidity -
- exhaustion
- dehydration
- electrolyte disturbance
- demoralised
- pain, fear
Risks of vaginal delivery -
Acute and chronic trauma to pelvic structures
Risks of c-section -
Trauma to abdo organs
Future labour complications
Anaesthetic complications Haemorrhage
What causes the onset of labour?
Forces of release > forces of retention
Forces of retention:
- Progesterone
- Adrenaline
- Cervix firm and fibrous
- Hypervolemia
- Relaxin
- CRH
Why is hypervolemia a force of retention?
Inhibits release of oxytoxin and vasopressin from PP gland
Forces of release:
Oestrogen Oxytoxin Vasopressin Cortisol Prostaglandins CRH Uterine distension
Hormones which increase contractions:
Oxytocin
Vasopressin
Oxytocin and vasopressin are released from:
Posterior pituitary gland
Cortisol from the foetal adrenal gland blocks the action of:
Progesterone
Function of prostaglandins:
Sensitise uterine muscles to oxytocin receptos
Cause cervical dilation
Posterior border of pelvic inlet
Sacral promontory
Anterior border of pelvic inlet
Pubic symphysis
lateral border of pelvic inlet
Iliopectineal line
Lateral border of pelvic outlet:
Ischial tuberosity and sacrotuberous ligament
Posterior border of pelvic outlet:
Tip of coccyx
Anterior border of pelvic outlet:
Pubic arch
Transverse diameter is greater where
Inlet
AP diameter is greater where
Outlet
Most common female pelvis shape =
Gynecoid
Most common male pelvis shape =
Android
Gynecoid pelvis =
Wider and broader outlet Oval-shaped inlet Less prominent ischial spines Greater angles sub-pubic arch Shorter sacrum
Android pelvis =
More triangular
narrow pubic arch
Anthropoid pelvis has a wide =
AP diameter
Platypelloid pelvis has a wider =
Transverse diameter
Pelvic floor is innervated by =
Pudendal nerve
What can be used to make contractions more coordinated and efficient?
Oxytocinon drip
Most favourable diameter of baby’s head =
Suboccipito-bregmatic
Suboccipital bregmatic diameter =
Babies head flexed
Type of presentation that required C-section as diameter is too large to fit through pelvis =
Brow-presentation
Best diameter to present of hear (number)
9.5 cm - fully flexed or fully extended
How to feel for babies position:
Feel sagital sututre and fontanelles
Shape of anterior fontanelle -
Diamond
Shape of posterior fontanelle
Triangle
Positions of head:
- OA (LOA, ROA)
- OP (LOP, ROP)
- OT (LOT, ROT)
‘Cardinal movements of labour’
- Engagement
- Flexion
- Internal rotation
- Extension
- External rotation
- Expulsion
Internal rotation =
Transverse to OA
What position is head when babies head is visible?
OA
External rotation =
OA to transverse
Presentations:
Chephalic
Shoulder
Breach
Effacement =
Cervix soften, become thinner
Stages of labour (1)
Onset of contractions, first irregular and then more regular.
0-4 cm then 4-10 cm
Cervix become effaced
How long does 1st stage last?
NP = 9 hrs P = 6 hrs
2nd stage of labour:
From full dilation to delivery
How long does 2nd stage last?
NP = 1 hr P = 15 mins
3rd stage of labour:
From delivery of baby to delivery of placenta
Why is active management of stage 3 important?
Post-partum heamorrhage
How to reduce blood loss:
Syntocininon, Syntometrine (oxytocin, syntocinon/gametrin) –> contraction of uterus
How is labour managed?
- Birth plan
- Partogram
- Regular bladder emptying
- Analgesia
- Vaginal exam
- Monitor mother and foetus
- Episiotomy
- Active management of 3rd stage
Why is regular bladder emptying important?
May effect descent of head into pelvis
Vaginal exams are performed every
4 hours
Ex of something to observe for
Sepsis
When is an episiotomy indicated?
Sign of perineum becoming over distended
Analgesia used in labour:
- TENS
- Entrenox
- Systemic opiates - pethidine, morphine
- Epidural
Ways to monitor fetal well being
Intermittent auscultation
Continuous monitoring
Why does a babies ECG look wiggly?
Receptors in fetal heart are more sensitive. Constantly change is response to minor changes. If baby becomes distressed, will lose ability to make microadaptations and line will flatten
